Provider Demographics
NPI:1548556293
Name:MITCHELL, COLLEEN A (PSY)
Entity Type:Individual
Prefix:DR
First Name:COLLEEN
Middle Name:A
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:PSY
Other - Prefix:DR
Other - First Name:COLLEEN
Other - Middle Name:A
Other - Last Name:MITCHELL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PSYCHOLOGIST
Mailing Address - Street 1:704 KATIE COURT
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:WI
Mailing Address - Zip Code:53523
Mailing Address - Country:US
Mailing Address - Phone:608-423-1100
Mailing Address - Fax:608-423-9851
Practice Address - Street 1:704 KATIE COURT
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:WI
Practice Address - Zip Code:53523
Practice Address - Country:US
Practice Address - Phone:608-423-1100
Practice Address - Fax:608-423-9851
Is Sole Proprietor?:No
Enumeration Date:2011-06-21
Last Update Date:2016-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071-008414103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical